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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT D PERMIT �• CALL 209 9553-77697 FOR INSPECTIONS p EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ItQJ D %l0" O-t�� 9P • CITY2IP rtrA-C,� 61530!4 CROSS STREET S N APN I-01 t J O PARCEL SIZE OWNER NAME E�'L L L)PE S PHONE C SI�� 1 z_'I O N OWNER ADDRESS S A YH y CITY/STATEIZIP CONTRACTOR L 1 r t)P,,.0 GAO Et 4liz- tj ML;-r j-v&L- PHONE 3(r,'1`037 J CONTRACTOR ADDRESS 4t)� w V CITY/STATE/ZIP L0� � C1, 2 L-4 L) LICENSE I C-42 !-.C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I I FRUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: L NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IMUM ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 SIGNED /%9 TITLE Ga/'jf" rfrV T DATE �-`CO^ Z D VPS IU3AJV 2020 COJJN N 1 q MENT DEPARTMENT US ONL Application Accepted Date Z-1 l7 Area Y/ 't�mployee ID# J� Final Inspection By Date SPECIAL PERMIT-Approved by Character of Soil tepth of 3 Ft: Pit/Sump Soil Chara ter: pf COMMENTS LD p. O/1 �a .��• Ih;✓)�/�'1C PE SC Received heck Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted Service Re^�uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT